Chronic hypertension in pregnancy is a risk factor for offspring long-term neurological morbidity

The prevalence of maternal chronic hypertension is on the rise. Hypertensive disorders of pregnancy are associated with adverse pregnancy and neonatal outcomes; however, offspring long-term outcomes are less investigated. We evaluated the long-term neurological morbidity of offspring exposed in-utero to maternal chronic hypertension, unrelated to preeclampsia.

A population-based retrospective study of singleton births (1991-2021) at a tertiary center. Deliveries of women with chronic hypertension (without superimposed preeclampsia) compared with women without chronic hypertension or any other hypertensive disorder. Offspring long-term (until age 18) neurological morbidity was compared from clinics and hospitalizations records. A Kaplan-Meier survival curve was used to compare the cumulative incidence of neurological morbidity and a Generalized estimation equation (GEE) model was constructed to control for confounders.

A total of 342,635 singleton births were included, 3,097 (0.9 %) were in mothers with chronic hypertension. The total neurological morbidity rate as well as the cumulative incidence of neurological morbidity over time (Kaplan-Meier, p < 0.001) was significantly higher in children exposed to maternal chronic hypertension as compared with unexposed children. The GEE model, controlling for repeated deliveries, maternal age, ethnicity, fertility treatments use, gestational age, child birth year and cesarean delivery, found that maternal chronic hypertension is an independent risk factor for offspring long-term neurological morbidity (aHR = 1.56, 95 %CI 1.34-1.81, p < 0.001).

Maternal chronic hypertension, unrelated to superimposed preeclampsia, is an independent risk factor for offspring long-term neurological morbidity. Nevertheless, the absolute risk remains relatively low. Further studies are warranted to elucidate underlying mechanisms and identify preventive strategies.